Utilization Review Specialist
$50k - $65kBanyan Treatment Centers
Utilization Review Specialist | Remote | Full-Time $50,000 – $65,000 Annually | Weekdays (Weekend Availability as Needed) Banyan Treatment Centers is seeking an experienced and detail-driven Utilization Review Specialist to join our corporate team. In this remote role, you'll manage a caseload of 50–75 patients, conducting admission and continuing-stay reviews, coordinating authorizations, and serving as a key liaison between Banyan's clinical operations and the managed care organizations that fund patient treatment. Your work directly protects patient access to care and keeps the business running. This is a high-volume, relationship-driven role for someone who thrives on precision, knows how to navigate managed care, and understands the stakes on both sides of the authorization process. About Banyan Treatment Centers Banyan Treatment Centers [ is a leading national provider of intensive treatment for individuals facing substance use and mental health disorders. Backed by TPG [ one of the nation’s largest private equity investors, Banyan is rapidly expanding access to high-quality, compassionate care. Why Join Our Team? * Mission-driven work with real business impact — your authorizations directly determine whether patients stay in treatment. Few roles sit closer to the intersection of clinical care and organizational sustainability. * Nationally recognized organization — Joint Commission–accredited, with 18 locations and telehealth services nationwide, and the infrastructure to support your work at scale. * Remote flexibility — work from anywhere while collaborating with clinical, billing, and operations teams across the country. * Collaborative environment — partner closely with clinical, operational, and billing teams to resolve outstanding case issues, support discharge planning, and ensure timely reimbursement. * Room to grow — join a rapidly expanding organization where UR professionals have visibility across the enterprise and opportunities to advance. * Comprehensive benefits including medical, dental, and vision insurance; whole and term life insurance; short- and long-term disability; 401(k) with employer match; paid time off and holidays; wellness incentives; and employee assistance and referral programs. Key Responsibilities * Manage a caseload of 50–75 patients, authorizing 15–25 cases daily and ensuring timely utilization reviews and appropriate level of care determinations * Conduct admission and continuing-stay reviews to assess medical necessity and ensure compliance with treatment standards * Verify insurance benefits, coordinate authorizations, and communicate effectively with external case managers and managed care organizations * Establish and maintain contracts with managed care companies and request rate increases when appropriate * Collaborate with clinical and billing departments to support discharge planning, documentation, and timely reimbursement
- Identify and address over- and underutilization trends
- Assist in resolving outstanding case issues with insurers
- High school diploma or equivalent
- Minimum one year of utilization review experience in a psychiatric or
- Strong organizational, documentation, and communication skills
- Ability to manage high caseloads with accuracy and efficiency
- Comfortable working independently in a remote environment
- Graduate degree in a health or behavioral health related field
- Clinical licensure (LCSW, LMHC, LPC, RN, or equivalent) — valued but not
$26 - $33 per hour
...are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Utilization Review Specialist joining our team, you’re embracing a vital mission dedicated to making communities healthier ®. Join us on this meaningful...SuggestedHourly payFull timeTemporary workPart time- ...Seeking an experienced and detail-driven Utilization Review Specialist, the full-time remote position will manage a caseload of 50-75 patients, conducting admission and continuing-stay reviews, coordinating authorizations, and serving as a liaison between clinical operations...SuggestedFull timeRemote work
- ...About the Role The Utilization Review Coordinator plays a critical role in ensuring that patients at our facility receive the appropriate level of care while managing treatment costs. This position involves coordinating, assessing, and authorizing treatment plans, collaborating...SuggestedFull timePart timeWeekend work
- ...County of San Diego is seeking a qualified Utilization Review Quality Improvement Specialist (RN, LCSW, LMFT, LPCC, or Clinical Psych) to review and interpret medical records for utilization review and medical necessity across County facilities in the San Diego area. The...Suggested
- ...Working remotely in a full-time capacity, the Behavioral Health Utilization Review Specialist will manage the authorization of treatment through insurance and managed care companies, performing pre-certification, concurrent, and appeal reviews while ensuring compliance...SuggestedFull timeRemote work
$24.03 - $24.75 per hour
...Utilization Review Specialist (51718) Henderson - 1711 Whitney Mesa - Henderson, NV 89014 Overview Salary Range $24.03 - $24.75 Hourly Position Type Full Time Education Level 2 Year Degree Description Position Summary: Person in this position is responsible...Hourly payFull timeWork at office$20 - $30 per hour
...A behavioral healthcare organization is seeking a Utilization Review Specialist to conduct clinical auditing and negotiate authorizations. The ideal candidate has a Bachelor's degree in Social Work or Nursing and 1-2 years of healthcare experience. Responsibilities include...- ...Medical Center Health System in Odessa, TX seeks a detail‑oriented support clerk to assist the Utilization Management department with utilization reviews, data collection, and care coordination activities. The position requires a high school diploma, at least one year...
- ...Coronis Health is seeking a remote Utilization Review Specialist to manage treatment authorization for behavioral health and substance abuse, interfacing with insurance and managed care entities. The role covers pre-certification, concurrent reviews, and appeals with a...Remote work
$50k
...the lives of patients and their families What to Expect (Job Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment team to gather necessary information for concurrent...Remote work- ...Utilization Review Specialist Position Summary: Under the direct supervision of the HIM manager, the UR specialist monitors the utilization of resources, risk management and quality of care for patients in accordance to established guidelines and criteria for designated...
- ...Overview Reviews clinical information and supporting documentation for outpatient or Part B services to determine appeal action. Reports... ...initial appeal action in order to optimize reimbursement and utilization of resources. Prepares response to appeal/request for...
- ...Purpose Statement Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Purpose Statement... ...organizations and the facility professional clinical staff. Conduct reviews, in accordance with certification requirements, of insurance...Work at officeLocal area
$30 - $45 per hour
...leading healthcare consulting agency is seeking an Operations Specialist III for a contract opportunity in Long Beach, CA. This role... ...Medi-Cal operations, along with experience in Epic EHR and Utilization Review. The selected candidate will perform chart reviews, ensure documentation...Hourly payContract workRemote work$1,920 - $2,129 per week
...Travel Non-patient Care (Utilization Review) ASUP Supplemental Health Care is hiring experienced travel Non-patient Care (utilization Review) ASUPs for contracts at a hospital in Washington, DC. With over 40 years as a nationally recognized staffing partner, we connect...Contract workLocal areaImmediate startShift work- ...Director of Utilization Review Under the direction of the Director of Utilization Review, the Specialist will coordinate Medicaid Managed Care authorizations and re-authorizations for clients receiving behavioral healthcare services from Odyssey House's Part 820 residential...Temporary workFlexible hours
- ...Utilization Review Specialist The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and compliant with regulatory standards. This position involves thorough evaluation of...Remote work
- Utilization Review Specialist Palm Springs, Florida, United States Yoso Recruiting
$17.44 per hour
...Utilization Review Specialist I Join a team that CARES! Here at ODMHSAS, we believe in I.C.A.R.E. Integrity, Compassion, Accountability, Respect, and Excellence. Our mission is to promote healthy communities and provide the highest quality care to enhance the well...Hourly payFull timeWork at officeFlexible hoursWeekend work$41.6k - $47k
...Utilization Review Specialist At Umpqua Health, we're more than a healthcare organization we're a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County, Oregon. We...Work at officeLocal areaImmediate startRemote workMonday to FridayFlexible hoursShift work- ...Utilization Review Specialist At Sycamore Springs, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that...Full timeLocal area
- ...Utilization Review Specialist The Utilization Review Specialist (URS) exercises independent judgment and professional discretion in the practice of case management to a select group of patients. The URS collaborates with physicians to ensure that patients are at the...Shift work
$56.97k - $84.75k
Work From Home Work From Home Work From Home, Indiana 46544 The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for appropriateness of setting and utilization. WHO WE ARE With 11 ministries and...Full timeWork at officeLocal areaWork from homeMonday to Friday$29.62 - $45.31 per hour
...Responsibilities Be responsible for all core functions in the Prior Authorization (PA) Department Coordinate and execute the review and research functions required to support the PA Department Investigate, review, and prepare all requests for prior authorization...Minimum wageFull timeWork experience placementLocal areaRemote workShift work$20 per hour
...Expected: Perform admission, continued stay and discharge reviews on all managed care clients. Maintain positive relationships... ...Intermediate level, Word- Intermediate level. 3-5 years’ experience in Utilization Review or related position in a healthcare setting. Job-...Full timeWork at officeLocal areaFlexible hours- Gateway Regional Medical Center, Inc. is seeking a full-time Utilization Review Specialist RN responsible for conducting admission and concurrent reviews to avoid payment denials, while managing appeals. This role requires collaboration with interdisciplinary teams to enhance...Full time
$27.07 - $33.37 per hour
...thinking, exceptional leadership, teamwork, and communication skills. ESSENTIAL DUTIES The primary responsibility of the Utilization Review Specialist is to review medical records and prepare clinical appeals (when appropriate) on medical necessity, level of care, length...$69.72k
...Payer Relations Specialist UWMEDICINE CONTRACTING & PAYER RELATIONS has an outstanding opportunity for a PAYER RELATIONS SPECIALIST... ...managed care contracting activities. Assist with drafting, reviewing, and maintaining contract documents and credentialing applications...Full timeContract workTemporary workWork at officeShift workDay shift- ...Humana Healthy Horizons in Kentucky seeks a Utilization Management Behavioral Health Professional 2 to support coordination, documentation, and communication of medical services and benefit determinations. The role requires interpreting criteria and policies with independent...
- ...Job Description Job Description Utilization Review Specialist – Behavioral Health Facility We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing clinical documentation, ensuring...Remote jobFlexible hours
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